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Pain below ankle bone


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#1 bjs1965

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Posted 20 July 2004 - 06:46 AM

I am at a loss ...

I have had this pain, on the exterior of my right ankle, below the ankle bone since October of last year ... initially, after a great season of getting back to being race fit, it began as a sharp pain as I took the first few steps of my run, but "warmed up", then came back worse after cooling down. It eventually got to the point where the pain took longer to "warm up" and made walking with a limp inevitable.

I took six weeks off ... no improvement.

This year, I've tried: rest, running "through it", new shoes, strapping, supports, ice, heat, massage, anti-inflamatories, osteo-eze, stretching, swimming, sports drs, physios (2), podiatrists (3), osteopathy, cortizone, acupuncture, bone scan, MRI, ankle specialist ...

... no improvement.

Sure, I agree, complete rest may help ... but six weeks initially and there was no improvement ... something is wrong, but I can't find it!

Any thoughts/ideas would be welcome!

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#2 Steve 'The Footman'

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Posted 20 July 2004 - 07:22 AM

You did not mention what investigations you have had.  An MRI done while it is symptomatic would give you an idea what is damaged.  (do a big run first until it hurts alot)

The important thing is to positively identify the affected tissue in order to make an accurate diagnosis.  

Under the outside ankle bone (the lateral malleolus) is the calcaneus or heel bone, the calcanelfibular ligament, The peroneal tendons (PL,PB), the lateral calcaneal nerve.  The peroneal retinaculum and other soft tissues.

Treatment is dependent on the tissue affected.  That should be the first step.

#3 bjs1965

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Posted 20 July 2004 - 03:39 PM

Thanks Steve ... it was dx'd by my sports doctor as Sinus Tarsi Syndrome ... hence the Cortizone injection. When that had nil effect, he referred me to a North Shore ankle specialist/surgeon. He called the dx a "bullsh.. dx" and recommended orthodics. The orthodics did not improve the condition (in fact, they may have caused other problems). After 6-8 weeks of wearing/running with the orthodics I returned to see the ankle specialist who ordered the MRI which returned with nothing of any concern. He has told me to press on with ice/orthodics/stretching ... a flight to QLD may be in the wings!

#4 Vivienne

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Posted 20 July 2004 - 03:56 PM

bjs1965,

Quick question because I had what sounds like the same problem:

I had massive pain on the exterior of my right ankle below the ankle bone.  It got to the point where it hurt like buggery to just stand on it and walk after my runs.

I saw from your list that you saw one already, but I went to a podiatrist too and she told me it's because of pronating inwards (right foot rolling in as I landed).  Apparently that acts to crush that part of the ankle that is hurting (abnormal pressure).

You listed a lot of things you've done above except for orthodics.  Did the podiatrist recommend those?  Do you wear them?  I was skeptical at first.  Although stupidly expensive, they're definitely worth the investment.

Orthodics fixed my problem immediately and I haven't had any issues with my ankle in 6 months.  It's starting to hurt again now, but that's only because I need to get new shoes.

#5 Vivienne

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Posted 20 July 2004 - 04:04 PM

Woops, sorry I must have been writing my response at the same time as yours!  I see that you have got orthodics.

Sorry!

#6 Steve 'The Footman'

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Posted 20 July 2004 - 04:33 PM

The Sinus Tarsi is the cavity in front of the ankle bone, not below it.  Pain feels like it is deeper rather than superficial.  It is the interosseous ligament between the calcaneus and the talus that is usually affected.  Diagnosis is by pushing into the cavity at different stages of inversion (rolled out).  Overpronation (rolling in) can certainly be the cause of this pain.

However you described pain below the ankle bone and this has nothing to do with the sinus tarsi.

Treating lateral ankle pain with anti-pronation devices can often make the problem worse because oversupination (rolling out) is much more likely a cause.

You need someone to look at you walking and running barefoot and with shoes.  People blame pronation on too many injuries.  In fact people that underpronate get the most injuries.  There is disagreement about how much of an injury risk pronation is and even if people actually pronate.  (Good paper on the isb website by Stefanyshyn and Nigg "Do Pronators Pronate" that found that people who think they pronate, actually evert (roll out) the foot no more than those who think they do not pronate.

Sometimes if a certain treatment does not work that is because the premise underling the diagnosis could be wrong.  You really need someone who is a runner to watch you running.  Not sure where windang is but there should be someone who can help.

#7 bjs1965

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Posted 20 July 2004 - 04:34 PM

Hi SAR, that sounds a lot like my pain ... bad in the mornings, too?

First podiatrist recommended “off the shelf” inserts/supports from TAF, along with new shoes. This didn’t improve anything, but created another uncomfortable pain across the front of both feet. Unfortunately, this podiatrist was just about to close up shop, so passed me along to another podiatrist who, after consultation, said that orthodics were not necessary! But third podiatrist said I would benefit from orthodics ... Pain continues ...

#8 Bugsjuice

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Posted 26 November 2007 - 12:52 PM

Hi Guys - this pain below the ankle sounds very similar to the trouble I'm having. I'm pretty much a newbie at running (and the CR website) and I've found that after running, and most recently during running I can feel pain start to develop about an inch below my right ankle bone (on the outside).

I've been to a Podiatrist who told me my calves are too tight, hence undue pressure on the peroneal tendon ^_^ and, I need orthodics as both feet pronate [left much more severely than the right].  ;) Oh well, the joys of a 98kg boy starting to run for his life!

However all stretching, strengthening and exercises under the desk at work and watching the late news hasn't seemed to help... my last run (= 30mins on treadmill) the pain actually developed during the run, and not after. The tenderness / soreness / pain followed, though with numerous applications voltaren and stretching etc etc it seems to have dissipated almost completely.

Are orthodics the answer?

#9 bjs1965

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Posted 26 November 2007 - 02:41 PM

Welcome to Running and Coolrunning, Bugs ... I'm sure you will grow to love both!

Are orthodics the answer? Well, for me, after having ankle pain (same) for nearly four years, well-made orthotics have provided the only consistent relief in that time. They have not (yet) cured the pain, but I can certainly run pain-free for a greater number of days with them, than I was able to without them.

I can recommend The Foot Alignment Clinic in Marrickville, NSW.

#10 brizza

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Posted 27 November 2007 - 08:06 AM

bjs,do you have osteoarthritis?

#11 bjs1965

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Posted 27 November 2007 - 11:29 AM

View Postbrizza, on Nov 26 2007, 07:06 AM, said:

bjs,do you have osteoarthritis?


Brizz, it hasn't been diagnosed as such; from memory one scan did show a minor arthritic condition, but nothing that was acted upon ...

#12 brizza

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Posted 27 November 2007 - 11:59 AM

i think iknow what is going on with your foot but i would have to see you and have a look at your scans,orthotics,old shoes,as always i do pro bono(whatever that means) for crs,pm me if you are interested-briz

#13 Bugsjuice

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Posted 04 December 2007 - 10:24 AM

Thanks bjs - I'm feeling the love already, closely followed by the annoyance of not being able to run!!

I have seen a podiatrist and have orthodics mould waiting for the green light to have them prepared. I've no other scans or tests etc etc but will speak to the crew at Marrackville and see what they have to say.

I found the couch to 5k program and think that could be good for some strengthening and will at least get my "itchy feet" moving...here's hoping!!

Bugs ;)

#14 Rizzo

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Posted 30 August 2008 - 08:29 PM

View PostBugsjuice, on Dec 4 2007, 10:24 AM, said:

Thanks bjs - I'm feeling the love already, closely followed by the annoyance of not being able to run!!

I have seen a podiatrist and have orthodics mould waiting for the green light to have them prepared. I've no other scans or tests etc etc but will speak to the crew at Marrackville and see what they have to say.

I found the couch to 5k program and think that could be good for some strengthening and will at least get my "itchy feet" moving...here's hoping!!

Bugs :)
]

I know I am digging up an old thread, but I am looking for more feedback/experiences from people who have orthotics from the foot alignment clinic.  I've had constant injuries over the past 12 months and it is due to the biomechanics in my feet/legs (or so I believe.)  It's getting to the point where I dont even want to get out of bed because I dont want to walk on my feet.  I have been to a physio, 2 osteos (one did absolutely nothing, the other was awesome) and 2 podiatrists.  I have had 2 sets of orthotics made and I'm a little bit hesitant to get another made because I am sick of spending money to only be disappointed.

Anyone give me a bit more insight to this place?   I'm kinda desparate so I will probably go there anyway but I think if it doesnt work I might crack... (running/sport/cycling is my life and I am struggling without it.)

#15 Bugsjuice

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Posted 11 September 2008 - 08:08 PM

View PostRizzo, on Aug 30 2008, 08:29 PM, said:

]Anyone give me a bit more insight to this place?

Hey Rizzo - sorry to hear things haven't been going according to plan. I never ended up speaking the these guys (purely by chance) in that I followed my parnter and saw Andrew Bull (PodRunner on here) at Sydney Sports Medicine in the CBD. I've had no problems thus far, except something happening now again, about this initial thread believe it or not!

I would have thought you should be entitled to go back to the people you got the othotics from and at least have them corrected and at least checked further - after all, they made them for you and if they don't work, they aren't right. Best to check to see what they say.

I'm learning to understand that - much like finding the best pair of shoes - it's hard to find the right medical people around.

Good luck.

Bugs

#16 Rizzo

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Posted 06 October 2008 - 01:38 PM

View PostBugsjuice, on Sep 11 2008, 08:08 PM, said:

Hey Rizzo - sorry to hear things haven't been going according to plan. I never ended up speaking the these guys (purely by chance) in that I followed my parnter and saw Andrew Bull (PodRunner on here) at Sydney Sports Medicine in the CBD. I've had no problems thus far, except something happening now again, about this initial thread believe it or not!

I would have thought you should be entitled to go back to the people you got the othotics from and at least have them corrected and at least checked further - after all, they made them for you and if they don't work, they aren't right. Best to check to see what they say.

I'm learning to understand that - much like finding the best pair of shoes - it's hard to find the right medical people around.

Good luck.

Bugs

Thanks for your response Bugs.  I didnt want to go back to the 2nd podiatrist cos i didnt get a real good vibe from him anyway and he told me the leg length difference shouldnt matter (even though I can feel it!) The first one had a few goes at trial and error with the orthotics and was happy for me to keep going back at no charge til she got it right but I am kind of over recovering from an injruy only to have it aggravated by the orthotics.

So last week I went and saw Neil Smith at the Foot Alignment Clinic. I was really happy with his attitude and confidence.  Mine is pretty much a text book case.  I have a leg length difference so he took the casts of my feet and sent me off to get a scan to find out how much.  It's only about 6mm or so (i havent got the result yet) but I have really flexible feet which in combination with the leg length difference cause me to overpronate in my left foot and supinate in the right.  
I am confident that if anyone can fix my problem he can, because his method is much more quantified than anything else I have seen.

I am going back this week for the fitting, so fingers crossed it all works out.  I'll post on here the outcome whichever way it turns out.


I also have been using  TP Therapy roller and ball to alleviate the pain in the meantime. I am at the stage of only using them every 3-4 days and I dont think i have ever used them for much more than 5 minutes at a time. I was recommended these about 6months ago, but put off buying them because they dont look like they are worth the price... but when you compare it to $50 for a massage then it has paid itself off in about a month. And they are much more convenient and take less time to use than an hour long massage.

Edited by Rizzo, 06 October 2008 - 04:37 PM.


#17 bjs1965

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Posted 13 October 2008 - 07:59 PM

View PostRizzo, on Oct 5 2008, 01:38 PM, said:

So last week I went and saw Neil Smith at the Foot Alignment Clinic. I was really happy with his attitude and confidence.  Mine is pretty much a text book case.  I have a leg length difference so he took the casts of my feet and sent me off to get a scan to find out how much.  It's only about 6mm or so (i havent got the result yet) but I have really flexible feet which in combination with the leg length difference cause me to overpronate in my left foot and supinate in the right.  
I am confident that if anyone can fix my problem he can, because his method is much more quantified than anything else I have seen.

I am going back this week for the fitting, so fingers crossed it all works out.  I'll post on here the outcome whichever way it turns out.

Hi Rizzo, I came across your post as I was checking on some old posts of mine ... I'm glad you've been to see Neil, and I'm looking forward to your posting your outcome. As a postscript to my seeing Neil, now over 14 months ago, I am still running pain-free many thanks to his diagnosis and treatment. In fact, this year, after running pain-free since November 2007, I ran my fastest C2S in over 16 years ... cheers to Neil and his Foot Alignment Clinic ... I'm first in line for when he decides to sell shares!  :)

#18 Bugsjuice

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Posted 27 October 2008 - 12:41 PM

Turns out the pain below my ankle bone is actually peroneal tendonopathy.

Went to a sports physician to get another opinion as I developed this problem with my orthotics, and my two very different feet are positioned basically the same. Seems the alternate opinion believes that my near neutral right foot (the problem foot) is lifted to far and I've strained the tendon. Rizzo - sounds like our feet do the same thing. My left pronotes a lot, but the right doesn't do much at all.

Now it's my turn to see whether I can get any money back for $500 orthotics that cause injury.

Bugs